Wow....nice offer

[PADPM]

I received this email regarding a job opening.

Moderators, please note that I am NOT posting this as an advertisement or solicitation for employment. I have simply posted this to show those who keep asking about income potential.

Please note that there is no mention that the position must be filled by an orthopedic foot/ankle surgeon. Regardless, who ever obtains this position is going to have to produce a LOT of money to receive a salary of $600,000. With an average overhead of about 50%, that ONE doctor would have to generate 1,2 million by himself/herself just to break even???



Job Title: Foot and Ankle Specialist – $600,000
Company: Arthur XXXXXX

Location: Midwest, Iowa

Date Posted: 11/23/2011
Full Time/Part Time: Full Time
Permanent/Temporary: Regular
Employment/Contract Work: Employment
Visa Waiver Available: N/A
Job #: 1265077

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Job Description

Join an established group of fifteen orthopedics recognized as the preferred group in the region.

Cutting-edge, $50 million, 225,000-square-foot facility has everything:
• All digital
• 1.5 Tesla MRI ready to go to 3T
• PET CT
• Fully-integrated EMR

This award-winning city offers a wide variety of amenities:
• Museums, theatres and symphony
• Local, international airport
• Semi-professional sports
• Multiple recreational parks
• Seasonal concerts and festivals
• Blue Ribbon public schools

City recognized as one of Americas Best Places to Grow Up based on variables such as low crime rate, low cost of living and comprehensive healthcare.
Contact Information

For more information on this opportunity, please contact XXXat (866) XXXXXX or (214XXXXX, via email at com or fax your CV to (214) xXxxxX.

Please reference 801.

---

Members don't see this ad.

 

[darazon]

I call dibs

 

[347932]

If there is no "all-you-can-eat" Iowa sweet corn involved in this deal then I'm not interested. Quite unfair if you ask me.

Omg I'm LMFAO...

Back to the topic.

That is a crazy job opportunity, but I just wonder what they're looking for. The rest of the group are Orthopedists. If they are looking for a Podiatrist or a F&A, this could be a tremendous opportunity for one of our younger colleagues.

One of our resident members here should look into it and perhaps share what they find out!

Excellent post PADPM!

 

[PADPM]

Sorry it took me so long to respond. My flight to Iowa was delayed and I just landed..........hope my interview goes well.

 

[zane870]

Sorry it took me so long to respond. My flight to Iowa was delayed and I just landed..........hope my interview goes well.

Can you put in a good word for me with your partners at your former practice. Maybe they can hold a spot for me and I'll fill it in ~5.5 years

 

[newankle]

I received this email regarding a job opening.

Please note that there is no mention that the position must be filled by an orthopedic foot/ankle surgeon. Regardless, who ever obtains this position is going to have to produce a LOT of money to receive a salary of $600,000. With an average overhead of about 50%, that ONE doctor would have to generate 1,2 million by himself/herself just to break even???


Please reference 801.

The argument always brought up saying you have to bring in a certain number of dollars to cover yourself based on overhead is a podiatry/small practice thing. When you are talking about a large practice like this opportunity those rules don't apply because it is far more complicated. I know because that is how our practice operates as well. We have so many other sources of income besides direct collections from surgeon's services such as imaging, PT, drug infusions, multiple forms of DME that some of that more than covers some salary shortcomings. For example, this fiscal year that just ended was my 3rd year with the practice. I took home 42% of what I collected directly which came out to roughly $630K x 0.42 = $265K. In addition we pool all our "stark money" together which is income from PT, ASC, and DME (braces/boots based) and divide it among partners equally so I received $70K from that. I also got a production-based bonus based on my percentage of the total income compared to others and how much the practice made above projected budget so I got roughly $35K from that. So I ended up taking home roughly $370K in the end. That would be a hell of a lot better if we did a better job at in-office drug dispensing and if we were allowed by the state to own and bill for MRI services. That would have likely been at least $470. Now what I brought into the practice is $630K for direct billings plus $150K collected for ankle brace and CAM boot based DME plus probably another $100K in custom orthotic business I send to the physical therapists to do plus all the business I send the therapists for physical therapy and I'm one of the top referrers for that so I brought in well over $900K to the practice. The point is that in large practices that provide multiple services, the "formula" is much more complicated but the rewards are also potentially much better. It's not a simple A+B=C thing.

 

[PADPM]

The argument always brought up saying you have to bring in a certain number of dollars to cover yourself based on overhead is a podiatry/small practice thing. When you are talking about a large practice like this opportunity those rules don't apply because it is far more complicated. I know because that is how our practice operates as well. We have so many other sources of income besides direct collections from surgeon's services such as imaging, PT, drug infusions, multiple forms of DME that some of that more than covers some salary shortcomings. For example, this fiscal year that just ended was my 3rd year with the practice. I took home 42% of what I collected directly which came out to roughly $630K x 0.42 = $265K. In addition we pool all our "stark money" together which is income from PT, ASC, and DME (braces/boots based) and divide it among partners equally so I received $70K from that. I also got a production-based bonus based on my percentage of the total income compared to others and how much the practice made above projected budget so I got roughly $35K from that. So I ended up taking home roughly $370K in the end. That would be a hell of a lot better if we did a better job at in-office drug dispensing and if we were allowed by the state to own and bill for MRI services. That would have likely been at least $470. Now what I brought into the practice is $630K for direct billings plus $150K collected for ankle brace and CAM boot based DME plus probably another $100K in custom orthotic business I send to the physical therapists to do plus all the business I send the therapists for physical therapy and I'm one of the top referrers for that so I brought in well over $900K to the practice. The point is that in large practices that provide multiple services, the "formula" is much more complicated but the rewards are also potentially much better. It's not a simple A+B=C thing.

I understand your comments, and your point is well taken. However, your comments further strengthen my comments that for this doctor to make $600,000, he'd have to bring in at least 1.2 million.

I FULLY understand the idea of ancillary sources of income, etc., etc., but even in your case when you do have ancillary sources, you have stated you have grossed the practice 900,000 and brought home a very respectable 370,000. That's LESS than 50%. Doesn't that in essence support my comments?

 

[newankle]

I understand your comments, and your point is well taken. However, your comments further strengthen my comments that for this doctor to make $600,000, he'd have to bring in at least 1.2 million.

I FULLY understand the idea of ancillary sources of income, etc., etc., but even in your case when you do have ancillary sources, you have stated you have grossed the practice 900,000 and brought home a very respectable 370,000. That's LESS than 50%. Doesn't that in essence support my comments?

I wasn't trying to really prove or disprove but...
In my situation yes the numbers work out so I do more than pay for myself but the point is that when there are multiple sources of revenue a practice can absorb some lost cost. So a larger more diverse practice can afford to bring on new practitioners easier and not feel as much of a hit. It all comes down to getting patients in the door - period. If you can do that you can make your practice bigger and bigger and bigger. One of our orthopds lost her father and was out for 3 months so her collections suffered. We all take an annual salary of what is chosen ($245K for orthopods, $230K for me) and at the end of the year we settle up as discussed in my last post. We like to take an annual salary (what we get paid biweekly) something we feel comfortable we can cover but if you don't cover, there are consequences. So for that orthopod that fell short she was asked to not take her "stark money" or other bonus at the end of the year to cover her loss in production. That way the practice lost no money and it is also good for the practice to pay bonuses at the end of the year, not during the year for cash flow reasons.
Are you guys seeing practices forming corporations (supergroups) to save money on overhead and more importantly have more bargaining power when negotiating rates with insurance carriers? It is big in the northeast. We are in discussions/plans for an ortho supergroup of near 200 but care must be taken because of anti-trust regulations.

 

[PADPM]

I wasn't trying to really prove or disprove but...
In my situation yes the numbers work out so I do more than pay for myself but the point is that when there are multiple sources of revenue a practice can absorb some lost cost. So a larger more diverse practice can afford to bring on new practitioners easier and not feel as much of a hit. It all comes down to getting patients in the door - period. If you can do that you can make your practice bigger and bigger and bigger. One of our orthopds lost her father and was out for 3 months so her collections suffered. We all take an annual salary of what is chosen ($245K for orthopods, $230K for me) and at the end of the year we settle up as discussed in my last post. We like to take an annual salary (what we get paid biweekly) something we feel comfortable we can cover but if you don't cover, there are consequences. So for that orthopod that fell short she was asked to not take her "stark money" or other bonus at the end of the year to cover her loss in production. That way the practice lost no money and it is also good for the practice to pay bonuses at the end of the year, not during the year for cash flow reasons.
Are you guys seeing practices forming corporations (supergroups) to save money on overhead and more importantly have more bargaining power when negotiating rates with insurance carriers? It is big in the northeast. We are in discussions/plans for an ortho supergroup of near 200 but care must be taken because of anti-trust regulations.

Your points are well taken and as stated, I do understand that there are many other avenues for large practices to stream income, in addtion to the actual production of the doctor. However, as a general rule, I think it's safe to say that the vast majority of practices want to make sure that they're not going to take a loss by hiring a doctor and want to also make sure that doctor pays for him/herself without factoring in the other sources that contribute to everyones bottom line.

I fully understand that you are obviously very productive for your group, but I'm honestly surprised to learn that the orthopods in the group are only taking a draw of $245,000. I understand they will get more based on your formula, but I would think they would want more up front. Due to the nature of some of their work with hip, knee implants, etc., they often have the ability to bill some larger ticket items.

Yes, my friend who practices in New Jersey is involved with that group who is forming a "supergroup". Unlike a specialty group where I live where the members of this specialty TRULY formed one very large practice, the NJ "supergroup" is really more a a group practice without walls. Each practice is maintaining it's autonomy, and is only sharing certain common features such as billing, purchasing supplies, orthotic labs, etc. I believe they used part of their model based on some of Neal Frankel's work in the Chicago area many years ago. I know there were similar groups of DPMs who tried this in the Florida area and were disappointed when they learned that insurance companies still weren't interested in negotiating, despite their size. I know that Hal Ornstein, who organized the NJ group has also been helping docs in Ohio and Texas.

David Helfman really formed a TRUE supergroup in the Atlanta area by merging many offices and these offices are truly "one" practice (Village Podiatry).

We have a relatively decent size group practice (as far as podiatric practices go) and we are considering discussing a possible merger with another decent size group, but even if it worked out, I would hardly call it a "super" group.

 

[Xforward22]

Sorry it took me so long to respond. My flight to Iowa was delayed and I just landed..........hope my interview goes well.

Did you really interview here? If so, how did it go and what did you find out? Are they interested in podiatrists?

I met a podiatrist who recently got hired into an orthopedic group as the only pod in the practice, and he was taking over for a foot and ankle orthopod who just left. They were originally in the market for another orthopod, but they gave him an interview anyway and ended up hiring him on. It's great to hear stories like that as the field of podiatry continues to make strides toward parity with MDs. My goal is to get hired on with a multispecialty group, at least now anyway. I'm young and things change

 

[PADPM]

Did you really interview here? If so, how did it go and what did you find out? Are they interested in podiatrists?

I met a podiatrist who recently got hired into an orthopedic group as the only pod in the practice, and he was taking over for a foot and ankle orthopod who just left. They were originally in the market for another orthopod, but they gave him an interview anyway and ended up hiring him on. It's great to hear stories like that as the field of podiatry continues to make strides toward parity with MDs. My goal is to get hired on with a multispecialty group, at least now anyway. I'm young and things change

No, I was only joking. As stated (too many times), I'm a partner in a very large, busy and successful practice, though the offer in the ad was certainly tempting.

Please realize that just about every young student or resident I've spoken with in the past 2 years would like to work with a multi-specialty group or with/for an orthopedic group. However, the reality is that not ever grad is going to land one of these great opportunities and many will have to go the more traditional route of opening practice, working for an existing practice or purchasing an existing practice. And those docs can also make an excellent living.